Informed consent dilemma

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Hi,

I'm a student and I'm trying to answer a question:

Husband is translating for wife who is the patient. He is making decisions on her behalf and isn't really translating everything. It's hard to tell what she thinks because she doesn't speak a work of English. How do you proceed in a respectful way?

Thanks!

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Specializes in Cardiac Telemetry, Emergency, SAFE.

What does hospital/facility policy say? Is there a hospital provided translator and if not is there a Cyraphone (translation) phone to use?

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Specializes in Trauma Surgical ICU.

Our policy states family members can not be the translator for consent, medical information etc.. We must use the hospital approved translator or the phone..

For basic questions we can use the family..

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Specializes in FNP.

Interpreter.

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There are serious ethical and clinical concerns about using family members to translate in clinical settings (beyond casual conversation). What options ("live" translators, translation telephone line) does your facility offer? I would not agree to continue in a situation where the husband (or any other family member) was doing the translating. Your facility needs to provide qualified translators.

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Specializes in Trauma Surgery, Nursing Management.

I can see that your professor is wanting you to delve into the ethics of informed consent. Although the husband makes all of the medical decisions for the wife, she still has the right to know what exactly she and her husband are consenting to.

There are a myriad of untoward events that could commence when a pt does not fully understand informed consent. The fact that the husband is making decisions for her could come into question if the wife is competent enough to make decisions for herself. In other words, if the language barrier is the only factor in the wife electing her husband to make medical decisions, Risk Management should be contacted and then should meet with both the husband and the wife along with a hospital approved translator in order to ensure all parties have a complete understanding of informed consent and its consequences.

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Specializes in ER, ICU.

This is why some hospitals do not allow family members to translate, and I agree. This is a perfect example.

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I really appreciate your feedback, it's been really helpful in formulating my ideas about this tricky question.

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This is why some hospitals do not allow family members to translate, and I agree. This is a perfect example.

Agreed. We have to get a hospital approved translator with good reason.

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Specializes in Emergency Medicine.

Just to clarify here...

A translator is used to define the meaning documents.

An interpreter is used to communicate verbally.

Not all interpreters are translators...

You begin with an interpreter to determine whether or not someone understands what you are telling them about the procedure or treatment. What's involved. Benefits, risks and so on.

Your translator gets involved before they sign a document not printed in their language.

The problem with using family members is that they might be considered "functional" with the use of english but not be able to interpret medical procedures or jargon. This is especially tricky with respect to nationality and different dialects. Cultural problems is another beast altogether.

If you detect there is some confusion about something and there is no immediate life-threatening concern STOP. Use your resources available and have everything clarified BEFORE the procedure.

Remember, if you are working in a hospital it's not just a responsibility it's the law.

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Specializes in Trauma Surgery, Nursing Management.
Just to clarify here...

A translator is used to define the meaning documents.

An interpreter is used to communicate verbally.

Not all interpreters are translators...

You begin with an interpreter to determine whether or not someone understands what you are telling them about the procedure or treatment. What's involved. Benefits, risks and so on.

Your translator gets involved before they sign a document not printed in their language.

The problem with using family members is that they might be considered "functional" with the use of english but not be able to interpret medical procedures or jargon. This is especially tricky with respect to nationality and different dialects. Cultural problems is another beast altogether.

If you detect there is some confusion about something and there is no immediate life-threatening concern STOP. Use your resources available and have everything clarified BEFORE the procedure.

Remember, if you are working in a hospital it's not just a responsibility it's the law.

VERY well thought out post, EmergencyNrse. Thanks for describing the difference between interpreter and translator. I have used these terms interchangeably, and will no longer do so.

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VERY well thought out post, EmergencyNrse. Thanks for describing the difference between interpreter and translator. I have used these terms interchangeably, and will no longer do so.

(Ditto.)

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